The subversion of Mill and the ultimate aim of nursing

Abstract

This is lightly edited and referenced version of a presentation given at the 20thInternational Philosophy of Nursing conference in Quebec on 23rd August 2016.Philosophical texts are not given the same prominence in nurse education as their more valued younger sibling, primary research evidence, but they can influence practice through guidelines, codes and espoused values. John Stuart Mill's harm principle, found in On Liberty, is not a universal law, and only a thoroughgoing libertarian would defend it as such, though it, or its remnants, can be seen can be seen in policy documents. But its influence is weakening. Smoking bans in enclosed spaces were initially justified with other-regarding considerations, but judgements from unsuccessful legal challenges from patients in UK psychiatric hospitals rely on preventing harm to the smoker, even when smoking outside, which does not harm others. In the wake of legislation, no-smoking policies enacted by hospitals are becoming more aggressive, banning smoking both inside and outside, and extending the use of power gained through employment to prevent nurses assisting patients enjoy a lawful habit. Mill's dictum has been subverted, and this speaks to the fundamental purpose of nursing.Should nurses collude and willingly exert their power for their version of the good of the patient? Or should they instead reaffirm values that support and facilitate life choices made by autonomous people? The paper supports the latter option, and this has wider application for nursing which can be illuminated, if not settled, by revisiting Mill and his famous dictum. K E Y W O R D SJohn Stuart Mill, no smoking policy, On Liberty, Rampton, Smoking | INTRODUCTIONWhen thinking about how I could make best use of this kind invitation to speak, I recalled a conference (I won't say which) some years ago. Two plenary speakers stick in the memory. The first was a wellknown nurse academic, who gave every impression that he was speaking completely off the cuff. He was to the extent that there were no notes and plenty of animation, but it soon became apparent that this was because it was little more than an introductory lecture, probably delivered in the same way to lecture halls full of bemused first semester undergraduates every September for many years. I went to coffee wondering whether he was worth the airfare.The second was a distinguished philosopher, and her paper was so dense and detailed that it passed straight over my head into the ether.Unlike the first speaker, she was reading her paper aloud. But it was a paper written to be read, not listened to. The complex ideas needed pause, a re-read and thoughtful application, and because as the education literature tells us, we have limited concentration spans, not least in a crowded and warm conference hall, her ideas were quickly lost. In my presentation, I aimed to steer the middle ground between these positions. I don't think that I said much that you haven't already heard but it's good to pause and revisit Mill and ask if we can lear...

“Resisting the Ban”

“…Similar to Douglas, Snelling (2015) argued that "direct evidence" for a smoking prohibitions policy is lacking because it is a "normative question". Following Mill, he argued that the social role of nurses is to "promote autonomous choice in health-effecting decisions" rather than working to "promote health at all costs" (Snelling, 2018). His position is like my own.…”

Four philosophical images of man and nursing from Krąpiec’s perspective

“…22-25;Maryniarczyk, 2015). This opinion may be supported by the growing number of publications focusing on awareness (Hussey, 2019), cultural (Cypress, 2019), sociological (Corry et al, 2018), structuralist (Nairn, 2017), evolutionary (Porter, 2019) and other anthropological models (Dewing, 2008;Sellman, 2008;Snelling, 2017). According to Krąpiec (2005), many of these models have lost the overall image of man, focusing on deconstructing the entire image of a man into elements and parts according to Descartes' (1998) belief that perfect cognition comes from knowing parts.…”